Provider Demographics
NPI:1245568260
Name:BLANKENSHIP MANAGEMENT CO.
Entity Type:Organization
Organization Name:BLANKENSHIP MANAGEMENT CO.
Other - Org Name:SOUTHRIDGE VILLAGE OF CONWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-327-3030
Mailing Address - Street 1:1306 S DONAGHEY AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6711
Mailing Address - Country:US
Mailing Address - Phone:501-327-3030
Mailing Address - Fax:501-327-3034
Practice Address - Street 1:1306 S DONAGHEY AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6711
Practice Address - Country:US
Practice Address - Phone:501-327-3030
Practice Address - Fax:501-327-3034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR044310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR179489794Medicaid